public health Flashcards
What are the 5 levelsof Maslows heirachy of needs
physiogial needs
safety needs
love and belonging
esteem
sel-actualisation
What is epigenetics
The study of how genes interact with the environment. Changes in organisms caused by modification of gene expression rather than alteration of the genetic code itself.
What is allostasis
The process of achieving stability, or homeostasis, through physiological or behavioural change.
What is allostatic load
The wear and tear on the body that accumulates as an individual is exposed to repeated or chronic stress. The price we pay for allostasis
Define domestic abuse
Incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16+ who are, or have been, intimate partners or family members regardless of gender or sexuality.
3 examples of domestic abuse
Emotional
physical
financial
sexual
psychological
How man domestic abuse impact on health?
- Traumatic injuries following assault e.g. fractures, miscarriage.
- Somatic problems or chronic illness e.g. chronic pain, headaches.
- Psychological problems e.g. PTSD, depression, anxiety
Give 3 indication sof domestic abuse
Unwitnessed by anyone else.
Repeat attendances to GP or A+E.
Delay in seeking help.
Multiple minor injuries.
What assessment tool can be used to determine someones risk of domestic abuse?
DASH
What action would you take if someone was at high risk of domestic abuse?
Refer to MARAC or IDVAS
What is public health
The science and art of preventing disease, prolonging life and promoting health through organised efforts of society.
Define epidemiology
The study of the frequency, distribution and determinants of diseases and health-related states in populations in order to prevent and control disease.
Define incidience
The rate at which new diseases occur in a population in a certain time period.
Define prevelance
The proportion of a population found to have a disease at a point in time.
What is person-time a measure of
Person-time is a measure of risk. It is the sum of each individual’s time at risk ie. the length of time they were followed up in the study. It is the denominator in incidence rate calculations.
What value is used as the denominator in incidence rate calculations?
Person-time
What is relative risk
The risk in one category relative to another, for example, the ratio of risk of disease in the exposed to the risk in the unexposed. It tells us about the strength of association between a risk factor and a disease.
What calculation can be used to work out relative risk?
Incidence in exposed ÷ incidence in unexposed.
Define attributable risk.
The rate of disease in the exposed that may be attributed to the exposure. It tells us about the size of effect in absoloute terms.
How can you calculate attributable risk?
Incidence in the exposed - incidence in the unexposed.
What is NNT
A
Number needed to treat is the number of patients that need to be treated in order to have an impact on one person.
How can you calculate NNT?
1 / absoloute risk reduction.
Define Bias
A systematic deviations from the true estimation of the association between exposure and outcome.
name 2 forms of bias
selection bias
information bias
What is selection bias?
The people who choose to participate in screening programmes may be different from those who don’t. Proper randomisation is not achieved.
What is information bias
Information or measurement bias can be due to observer, participant or instrument error.
what is length-time bias
Diseases with a longer period of presentation are more likely to be detected by screening than ones with a shorter time of presentation.
what is lead time bias
Screening identifies diseases earlier and so gives the impression that survival is prolonged but in reality survival time is unchanged
define confounding
Confounders are associated with exposure and outcome but are not on the causal path from exposure to disease.
Confounders may affect the validity of a study.
What is the Bradford Hill criteria for causation?
Consistency.
Biological plausibility.
Temporality - cause before disease.
Dose response.
Reversibility.
Strength of association.
name 5 study design
Ecological.
Cross-sectional.
Case-control.
Cohort.
RCT.
Q
Which type of study uses routinely collected population level date to show trends and to generate hypotheses
Ecological study
Which type of study looks at the population at a point in time?
A cross-sectional or prevalence study
Which type of study compares people with a disease to those without a disease for age, sex, habits, class etc?
A case-control study. These are retrospective.
Which type of study follows a population over time to see if they’re exposed to the agent in question and if they develop the disease?
A cohort or incidence study. These are prospective.
WHat is RCT
Where a population is randomised to either an interventional or a control group. Often these are blind or double-blind trials.
Which type of study is also known as an incidence study?
A cohort study - follows a population over time to see if they’re exposed to the agent in question and if they develop the disease
Which type of study is also known as a prevalence study
A cross-sectional study. It looks at the population at point in time.
Define primary prevention
Preventing a disease/condition from occurring in the first place. Eliminating RF’s that contribute to the disease
Give an example of a primary prevention method.
immunisation
Define secondary prevention
Detecting a disease as soon as possible in order to alter its course and to improve health outcomes.
Give an example of secondary prevention.
cervical smear
Define tertiary prevention.
Trying to slow down disease progression, avoiding complications and helping people to manage their illness effectively.
Give an example of tertiary prevention.
Diabetes management - diet advice, exercise programmes, self-monitoring, annual foot checks etc
What is the population approach to prevention? Give an example.
Preventative measures delivered on a population wide basis e.g. dietary salt reduction
Q
What is the high risk approach to prevention? Give an example.
Identifying individuals above a chosen cut-off and treating them. E.g. treating those with high cholesterol to avoid heart disease
Describe the prevention paradox
A preventative measure that brings much benefit to the population often offers little to each participating individual
Define screening
Identifying seemingly healthy individuals who may be at increased risk of disease
Give 4 different types of screening
1.Population based.
2.Opportunistic.
3. Screening for communicable diseases.
4. Pre-employment and occupational.
What is the Wilson and Jungner criteria for screenin
- The condition being screened for should be an important health problem.
- The natural history of the condition should be understood.
- There should be a detectable early stage.
- There should be a treatment available.
- Facilities for diagnosis and treatment need to be available.
- There should be a suitable test.
- The test should be acceptable to the population.
- There should be an agreed policy on whom to treat.
- The costs of screening must be balanced against benefits.
- Screening should be a continuous process, not just a one off.
Define sensitivity
The proportion of people with the disease who are correctly identified (a/a+c).
Define specificity.
The proportion of people without the disease who are correctly excluded by the screening test; how well a test detects those without a disease (d/b+d).
Define PPV
The proportion of people with a positive test result who actually have the disease (a/a+b).
define NPV
The proportion of people with a negative test result who do not have the disease (d/c+d
What are the 4 main determinants of health?
Lifestyle.
Access to healthcare.
Genes.
Environment
Define equity and eqality
Equity - what is fair and just.
b) Equality - equal shares.
Define horizontal equity.
Equal treatment for equal need.
Define vertical equity.
Unequal treatment for unequal need e.g. someone with a common cold would need a different treatment to someone with pneumonia.
Give 2 factors that can affect equity.
- Spatial factors - geographical.
- Social factors - age, gender, class, ethnicity.
What are the 3 domains of public health?
1.Health promotion.
2. Health protection.
3. Improving health services.
Domains of public health: give examples of health promotion.
Health promotion looks at interventions e.g. immunizations, smoking cessation, screening.
Domains of public health: give examples of health protection.
Putting measures in place to control infectious diseases.
Domains of public health: what are the aims of health service improvements?
To ensure that there is delivery of organised, safe and high quality services.
What is health psychology?
Health psychology emphasizes the role psychological factors in the cause, progression and consequences of health and illness. It aims to put theory into practice by promoting healthy behaviors and preventing illness.
Give 3 types of health behaviour
- Health behaviour.
- llness behaviour.
- Sick role behaviour.
Define health behaviour
Health behaviour is aimed at preventing disease e.g. eating healthily.
Define illness behaviour
Illness behaviour is aimed at seeking remedy e.g. going to the Dr’s.
Define sick role behaviour
Sick role behaviour is activity aimed at getting better e.g. taking medications.
what are health damaging behaviours
Health damaging behaviours are often related to mortality e.g. smoking, alcohol, high risk sexual behaviours.
What are health promoting behaviours?
Behaviours that seek and maintain health e.g. exercise, eating healthily, having vaccines
What is a meta-analysis?
A statistical technique where you pool all the results of the available evidence and look at effect.
Define compliance
The extent to which a patients behavior coincides with medical advice. It is professionally focused and assumes that the doctor knows best.
Give 3 factors that can effect compliance.
- Side effects of medications.
- Patient perception of risk.
I3. f the patient is asymptomatic. - Socioeconomic status
Give 3 examples of population level interventions.
- PH campaigns e.g. Change4Life, Movember.
- Screening e.g. cervical smear.
- Immunisations e.g. MMR.
What is unrealistic optimism?
Unrealistic optimism is when individuals continue to practice health damaging behaviour due to inaccurate perceptions of risk and susceptibility.
Give 3 factors that contribute to unrealistic optimism e.g. factors that can influence someones perception of risk.
- Lack of personal experience with a problem.
- Belief that it may be preventable by personal action.
- Belief that if not happened now, its not likely to.
- Belief that the problem is infrequent.
- Other reasons: health beliefs, situational rationality, cultural variability, socioeconomic factors, stress, age.
Why is it important to understand a patient’s perception of risk?
A patient’s perception of risk can impact on medication adherence and keeping appointments etc.
Briefly describe the NICE guidance on behaviour change.
- Plan interventions.
- Assess social context.
- Educate and train.
- Look at individual level and community level interventions.
- Evaluate effectiveness and assess cost effectiveness
What is the single greatest cause of illness and premature death in the UK?
Smoking.
What 3 diseases are smoking related deaths normally due to?
Cancers.
COPD.
CHD.
When does smoking prevalence peak
mid 20
What is the role of NCSCT?
NCSCT supports the delivery of effective evidence-based tobacco control programmes and smoking cessation interventions provided by local services.
What is ‘Health Needs Assessment’?
A systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities
Health Needs Assessment: define need.
The ability to benefit from an intervention.
Health Needs Assessment: briefly describe the planning cycle.
Needs assessment -> planning -> implementation -> evaluation -> needs assessment etc…
what is felt need
Individual perceptions of variation from normal health.
What is expressed need?
When an individual seeks help to overcome variation in normal health
What is normative need
A
When a professional defines interventions that are appropriate for expressed need.
WHat is comparative need
Comparison between severity, range of interventions and cost.
Health needs assessment: define supply.
What is provided
Describe the difference between health need and health care need.
Health need: need for health.
Health care need: need for health care. It is more specific and looks at someone’s ability to benefit from health care.
Name 3 different types of health needs assessment.
Epidemiological.
Comparative.
Corporate.
Give 3 negative points for epidemiological health needs assessments
Required date may not be available.
Variable data quality.
Ignores felt needs.
Briefly describe a comparative health needs assessment.
Compares services received by one population with other populations.
Health needs assessment: define demand.
WHat people ask for
Give 3 negative points for comparative health needs assessments.
Required date may not be available.
Variable data quality.
It is hard to find comparable populations.
Who might be involved with corporate health needs assessment?
Politicians.
Press.
Providers.
Professionals.
Patients.
Give 3 negative points for corporate health needs assessments.
1.Difficult to distinguish need from demand.
2.Groups may have vested interests.
3.May be influenced by political agendas.
Q
Give one health related example of something that you consider is demanded but not needed or supplied.
Cosmetic surgery.
Smoking cessation: give 3 symptoms of withdrawal.
Difficulty concentrating.
Increased appetite.
Irritability.
Give 3 potential problems associated with polypharmacy.
Drug interactions.
Can affect compliance and lead to decreased patient satisfaction.
Pill burden.
What is QRISK
calculates someones risk of a CV event in the next 10 years.
3 causes of homelessness
Relationship breakdown due to:
Mental illness.
Domestic abuse.
Dispute with parents.
Bereavement.
Give 3 groups of people who are more vulnerable to homelessness.
Substance misusers.
Failed asylum seekers.
People who are/have been in care.
Ex-service men and women.
LGBTQ+.
What health problems do homeless adults face?
1.Infectious disease inc. TB and hepatitis.
2. Dental problems.
3. Respiratory problems.
4. Injuries following violence/rape.
5. Sexual health problems.
6. Serious mental illness - schizophrenia, depression.
7. Malnutrition.
What barriers to care do homeless people face?
Difficulty accessing health care.
Lack of integration between primary care services and other agencies.
People may not priorities health when there are other more immediate health problems.
May not know where to find help.
Communication difficulties.
Define refugee
A person granted asylum and refugee status in the UK. They have the rights of a UK citizen.
Define asylum seeker
A person applying for refugee status. They are entitled to £35 a week, housing and NHS care
What barriers to care do asylum seekers and refugees face?
Language/cultural/communication problems.
Money/other priorities.
Different perceptions of care.
Racism, prejudice, discrimination, stigma.
May not understand how the NHS works.
What health problems do refugees and asylum seekers face?
Injuries from war/travelling.
No previous health surveillance/immunisations.
Malnutrition.
Injuries from torture and sexual abuse.
Blood borne and infectious disease.
Untreated chronic disease.
PTSD, depression, psychosis.
Define social exclusion
The process of being shut out from any of the social, economic, political or cultural systems which determine the social integration of a person in society.
3 causes of lonliness
Poor health, sensory impairment.
Poverty.
Housing issues.
Fear of crime.
Lack of transport.
Discrimination
Give 3 national initiatives to combat loneliness.
Age UK.
Silverline.
Dementia Friends.
Give 3 Sheffield initiatives to combat loneliness.
Age Better.
Active Sheffield.
Darnall Dementia Care.
What is the Health Belief Model (Becker 1974)?
Individuals will change if they:
- Believe that they are susceptible to the condition in question.
- Believe that is has serious consequences.
- Believe that taking action reduces susceptibility.
- Believe that the benefits of taking action outweigh the costs.
What are the 4 key aspects to the health belief model?
Perceived susceptibility.
Perceived severity.
Perceived benefits.
Perceived barriers - most important factor for addressing behaviour change!
‘Cues to action’ are another important aspect of the health belief model. What is meant by this?
Internal cues e.g. worsening pain or breathlessness may trigger someone to want to change their behaviour.
External cues e.g. reminder letters or phone calls from GP.
Give 3 disadvantages of the health belief model.
- Health beliefs may be affected by alternative factors e.g. outcome expectancy and self efficacy.
- The model does not consider the influence of emotions on behaviour.
3.Cues to action are often missing in research. - It does not differentiate between first time and repeat behaviours.
The Theory of Planned Behaviour proposes that the best predictor of behaviour is intention. What are the 3 predictors of intention?
A persons attitudes to behaviour.
Subjective norm: the perceived social pressure to undertake the behaviour.
Perceived behavioural control: a person’s appraisal of their ability to perform the behaviour.
Theory of Planned Behaviour: Only 50% of intentions transfer to behaviours. How can we bridge this gap?
Perceived control.
Anticipated regret.
Preparatory actions.
Implementation intentions!
Relevance to self.
Give 3 disadvantages to the Theory of Planned Behaviour.
Lack of temporal element and lack of direction or causality.
The model doesn’t taken into account emotions.
The model doesn’t explain how attitudes, intentions and perceived behavioural control interact.
Relies on self-reported behaviour.
Good for predicting intentions but not as successful for actual behaviours.
Describe the transtheoretical model.
Pre-contemplation - no intention of stopping smoking.
Contemplation - thinking about giving up.
Preparation - getting ready to quit in near future.
Action - engaged in giving up.
Maintenance - steady no smoker, state of change reached.
Relapse?
Give 3 advantages and 3 disadvantages of the transtheoretical model.
Advantages:
Acknowledges individual stages.
Accounts for relapse.
Temporal element.
Disadvantages:
Not all people move through every stage.
Change might operate on a continuum, not discreet stages.
Doesn’t take into account habits, culture, social and economic factors.
Give 3 external factors that are important when thinking about behaviour change.
Impact of personality traits.
Assessment of risk perception.
Impact of past behaviour/habit.
Social environment.
NICE guidance suggests that there are certain transition points in a person life where they are more susceptible to behaviour change. Name 3.
Leaving school.
Entering workforce.
Becoming a parent.
Becoming unemployed.
Retirement and bereavement
Give 3 factors that contribute to the promotion of excessive energy intake.
Genetics.
Employment e.g. shift work.
Advertisements.
Characteristics of food - energy density, macronutrient composition, portion size.
Reduced physical activity.
Sleep.
Psychological factors.
Define malnutrition
Deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients. Malnutrition covers under-nutrition and overweight.
Name 2 early influences on feeding behaviour.
Human foetuses swallow amniotic fluid.
2. Breast feeding.
Give 3 advantages of breast feeding on feeding behaviour.
More likely to accept novel foods in weaning.
Less fussy eaters in childhood.
More likely to have a diet rich in fruit and vegetables.
Give 3 ways in which parents can tackle fussy eating.
Modelling healthy eating behaviours and eating as a family.
Provide a variety of food.
Avoid pressure to eat.
Restriction.
Authoritative parenting.
Not using food as a reward.
If associations are not causal, what might they be due to?
Confounding factors.
Chance.
Bias.
Reverse causation.
Who might combined hormonal contraception be contraindicated in?
BMI>35.
Smokers aged >35.
Those with a family history of VTE.
History of migraines with aura.
What are the Fraser guidelines?
The following criteria judge the competence of a young person to make decisions about contraception without parental consent:
The patient understands the advice given.
The patient cannot be persuaded to inform their parents.
It is likely that the patient will continue to have sexual intercourse with or without contraception.
The patient’s physical or mental health may suffer as a result of withholding contraceptive advice or treatment.
It is in the best interests of the patient and the doctor to provide contraception advice and treatment without parental consent.
What formula is used to work out how many units of alcohol there are in a drink?
Strength of drink (%ABV) X Volume (ml) / 1000
Section 2
Admission for assessment: allows compulsory admission for up to 28 days for assessment.
Section 2
Admission for treatment: allows compulsory admission for up to 6 months for treatment.
Section 4
Emergency admission: compulsory admission for 72 hours.
Section 135
A magistrate can authorise forced entry into a property where it is believed that a person is suffering from a mental health disorder.
Section 136
Used by police to take someone suffering from a mental health disorder from a public place to a place of safety.
“Structure, process, outcome” is a useful framework to use when carrying out evaluation of health services. Explain what is meant by “structure”.
Structure looks at what there is - buildings, staff, equipment. E.g. no. of ICU beds per 1000 or no. of vascular surgeons per 1000 or no. of locations screening takes place.
When assessing the quality of health services, Maxwell’s classification lists six dimensions. What are they?
Effectiveness.
Efficiency.
Equity.
Accessible.
Acceptable.
Appropriate.
Although using measures of health outcomes is desirable in evaluation of health services, there are potential limitations. Explain why it may be difficult to attribute a health outcome to the service provided.
Other factors may be involved.
There may be a time lag between service and outcome.
Large sample sizes may be needed.
Data may be unavailable or there may be issues with data quality.
Give 4 criteria for negligence.
Duty of care.
Breach in duty of care.
Patient harmed.
Patient was harmed due to breach in duty of care.
What is an NHS never event.
A serious, largely preventable patient safety incident that should never happen if the available preventable measures have been implemented e.g. checklists.
Give an example of an NHS never event.
Patient misidentification.
Misplacement of an NG tube.
Clinical errors can be managed using a systems approach and a persons approach. Describe the persons approach.
Errors are due to wayward mental processes e.g. negligence, inattention, distraction. Focuses on unsafe acts of staff on the front-line e.g. nurses, doctors.
Clinical errors can be managed using a systems approach and a persons approach. Describe the systems approach.
Adverse events are the product of many causal factors - a whole system is to blame (swiss cheese). Implementation of standardised working and developing error free processes.
